Pain relief in labour

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What pain relief will be available?

Media last reviewed: 20/03/2014

Next review due: 20/03/2017

Your pain relief options

Labour can be painful, so it’s important to learn about all the ways that you can relieve the pain. It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you. Ask your midwife or doctor to explain what's available, so that you can decide what's best for you.

Write down your wishes in your birth plan, but remember that you should keep an open mind. You may find that you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.

Self-help in labour

You will be more relaxed in labour and better placed to cope with the pain if you:

Learn about labour. This can make you feel more in control and less frightened about what's going to happen. Talk to your midwife or doctor, ask them questions and go to antenatal classes.

Learn how to relax, stay calm and breathe deeply.

Keep moving. Your position can make a difference, so try kneeling, walking around or rocking backwards and forwards.

Bring a partner, friend or relative to support you during labour, but if you don't have anyone, don't worry – your midwife will give you all the support you need.

Ask your partner to massage you (although you may find that you don't want to be touched).

Have a bath.

Gas and air (Entonox) for labour

This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help to reduce it and make it more bearable. Many women like it because it's easy to use and they control it themselves.

How it works

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. You'll probably practise using the mask or mouthpiece if you go to an antenatal class. The gas takes about 15 to 20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Side effects

There are no harmful side effects for you or the baby, but it can make you feel light-headed. Some women also find that it makes them feel sick, sleepy or unable to concentrate. If this happens, you can stop using it.

If gas and air doesn't give you enough pain relief, you can ask for a painkilling injection as well.

Pethidine injections in labour

Another form of pain relief is the intramuscular injection (into the muscle of your thigh or buttock) of a drug, such as pethidine or, less commonly, diamorphine. The injection can also help you to relax, which can lessen the pain.

How it works

It takes about 20 minutes to work after the injection, and the effects last between two and four hours.

Side effects

There are some side effects to be aware of:

It can make some women feel woozy, sick and forgetful.

If it hasn't worn off towards the end of labour, it can make it difficult to push. You might prefer to ask for half a dose initially to see how it works for you.

If pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing. If this happens, another drug to reverse the effect will be given.

The drugs can interfere with the baby's first feed.

Epidurals

An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour, or who are becoming distressed.

An anaesthetist is the only person who can give an epidural, so it won't be available if you give birth at home. If you think you might want one, check whether anaesthetists are always available at your hospital.

How much you can move your legs after en epidural depends on the local anaesthetic used. Some units offer "mobile" epidurals, which means you can walk around. However, this also requires the baby's heart rate to be monitored remotely (by telemetry) and many units don't have the equipment to do this. Ask your midwife if mobile epidural is available in your local unit.

An epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief.

What's involved in having an epidural?

To have an epidural:

A drip will run fluid through a needle into a vein in your arm.

While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic and then introduce a needle into your back.

A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs, usually a mixture of local anaesthetic and opioid, are administered through this tube. (An opioid is a drug that binds to special opioid receptors in the body, reducing pain.) It takes about 10 minutes to set up the epidural, and another 10 to 15 minutes for it to work. It doesn't always work perfectly at first and may need adjusting.

After it has been set up, the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine.

Your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby's head.

Side effects of obstetric epidurals

There are some side effects to be aware of:

An epidural may make your legs feel heavy, depending on the local anaesthetic used.

An epidural shouldn't make you sick or drowsy.

Your blood pressure can drop (hypotension); however, this is rare, because the fluid given through the drip in your arm helps to maintain good blood pressure.

Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby's head (instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing). This reduces the chance that you will need an instrumental delivery. Sometimes, less anaesthetic is given towards the end, so that the effect wears off and you can push the baby out naturally.

You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

About one in 100 women gets a headache after an epidural. If this happens, it can be treated.

Your back might be a bit sore for a day or two, but epidurals don't cause long-term backache.

About one in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You'll be advised by the doctor or midwife when you can get out of bed.

Water births

Water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature but not above 37.5C, and your temperature will be monitored.

TENS machines

This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire your own machine.

TENS has not been shown to be effective during the active phase of labour (when contractions get longer, stronger and more frequent). It's probably most effective during the early stages, when many women experience low back pain.

TENS may also be useful while you're at home in the early stages of labour or if you plan to give birth at home. If you're interested in TENS, learn how to use it in the later months of your pregnancy. Ask your midwife to show you how it works.

How TENS machines work

Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.

TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord.

Side effects of TENS machines

Alternative methods of labour pain relief

Some women prefer to avoid the types of pain relief listed on this page, and choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques are not proven to provide effective pain relief.

If you'd like to use any of these methods, it’s important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals don't offer them for pain relief during labour.